Adult Medicaid Manual MA-2352 TERMINATIONS/DELETIONS/EX PARTES

REVISED 10/01/11 – CHANGE NO. 15-11

I. POLICY PRINCIPLES

Whenever an individual is determined ineligible for Medicaid in any aid program/category he must be evaluated for ongoing Medicaid eligibility. Complete an evaluation to determine if the individual is eligible for any other aid program/category before terminating any Medicaid coverage for the aged, blind or disabled. The evaluation is to include Medicaid for the Aged, Blind, and Disabled (MAABD), including HCWD, MQB-Q, MQB-B, MQB-E, Qualified Disabled Working Individuals, NC Health Choice and Family and Children's Medicaid. Refer to III. below for exceptions to this policy.

The term “ex parte review” means to review information available to the agency to make a determination of eligibility, without requiring the recipient to come into the agency or make a separate application. A signed redetermination document is not required for an "ex parte review." The county must explore and exhaust all possible avenues of eligibility in all Medicaid coverage groups as well as NC Health Choice for Children. If information is not available to make a determination of eligibility, the county must provide the recipient reasonable opportunity to provide the necessary information.

Whenever an individual is determined ineligible for Medicaid at the end of a Medicaid certification period, a full redetermination must be completed. Always send appropriate notices before termination. Do not require the individual to provide information that does not change such as birth certificates, etc.

When reviewing ongoing Medicaid eligibility, if you establish eligibility in an aid program/category that requires the creation of a case in EIS, a signed application is not required. Enter the DSS-8124 as an administrative application or reapplication.

For example: MAD case is terminating due to no longer considered disabled. Evaluate the case for any other Medicaid coverage group, including HCWD Medically Improved Coverage, or NC Health Choice before terminating case. Client has a child in the home under 18 years old receiving Medicaid. Caseworker found the client is eligible for Medicaid for Families (MAF). The county should not require a signed application. Enter the DSS-8124 as a new administrative application.

REVISED 10/01/11 – CHANGE NO. 15-11

(I)

A. Exceptions

Refer to III below for the exceptions to continuing Medicaid when Medicaid, (both adult and family and children) including Work First, terminates.

B. Medicaid Ineligibility

When a individual is determined ineligible in a Medicaid only aid program/category, continue his authorization until each individual is determined eligible or ineligible for ongoing Medicaid in all other aid program/categories.

1. The aid/program categories include all Adult Medicaid categories, Family and Children's categories, as well as NC Health Choice. This includes the MQB's, and Qualified Disabled Working Individuals.

2. This may be an ex parte or a redetermination. See II. below.

C. Ongoing Medicaid Eligibility

When the ex parte review or redetermination is completed and ongoing Medicaid eligibility is established, authorize the individual for the appropriate aid program/category. MAABD authorization requires an unsigned administrative new application if ineligibility was in a Family and Children's Medicaid aid program/category. Follow policy rules to determine the appropriate certification period.

Example: MAD case at redetermination is found to no longer meet the definition of disability and does not meet the eligibility requirements for HCWD. Individual is eligible for MAF as caretaker due to a child receiving Medicaid in the home. This requires an unsigned administrative new application.